Summary & Overview
CPT 01160: Anesthesia for Pelvic Procedures (Except Hip)
CPT code 01160 represents anesthesia services for procedures performed on the pelvis, excluding the hip. This code is widely used by anesthesiology providers in outpatient hospital settings to document and bill for the administration of anesthesia during pelvic surgeries. Nationally, CPT code 01160 is recognized by major commercial payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, ensuring broad coverage and reimbursement for these services.
This publication provides a comprehensive overview of CPT code 01160, including payer coverage, clinical context, and relevant billing considerations. Readers will gain insight into the typical use of this code, associated service types, and the importance of accurate coding for anesthesia in pelvic procedures. The analysis also highlights common modifiers, associated taxonomies, and related ICD-10 diagnoses, offering a clear understanding of how CPT code 01160 fits within the broader landscape of anesthesiology billing and policy. Key benchmarks and policy updates are discussed to inform stakeholders about current trends and requirements for anesthesia services in pelvic surgery. This resource is designed to support healthcare professionals, administrators, and policy analysts seeking clarity on the application and significance of CPT code 01160 in clinical practice.
CPT Code Overview
CPT code 01160 is designated for anesthesia services provided during procedures on the pelvis (except hip). This code is utilized by anesthesiology professionals to indicate the administration and management of anesthesia for pelvic surgeries that do not involve the hip. The typical site of service for procedures billed under CPT code 01160 is an outpatient hospital (Place of Service 22), reflecting its common use in ambulatory surgical settings. This code is integral to ensuring accurate billing and documentation for anesthesia care in pelvic procedures, supporting both clinical and administrative needs within the healthcare system.
Clinical & Coding Specifications
Clinical Context
A patient is scheduled for outpatient pelvic surgery, excluding hip procedures, at an outpatient hospital (Place of Service 22). The patient may present with conditions such as a deviated nasal septum, chronic sinusitis, nasal polyps, or hypertrophy of nasal turbinates, which require surgical intervention. An anesthesiologist provides anesthesia services for the procedure, ensuring patient comfort and safety throughout the operation. The clinical workflow involves preoperative assessment, administration of anesthesia, intraoperative monitoring, and postoperative care in the recovery area.
Coding Specifications
-
Modifier
QS: Indicates that monitored anesthesia care (MAC) was provided during the procedure. Used when the anesthesiologist is present and monitoring the patient, but not providing general anesthesia. -
Modifier
P1: Designates the patient as a normal, healthy individual with no systemic disease. Used to indicate the physical status of the patient for anesthesia risk assessment.
| Provider Taxonomy Code | Specialty Description |
|---|---|
207L00000X | Anesthesiology |
207LA0401X | Pain Medicine (Anesthesiology) |
207LC0200X | Critical Care Medicine (Anesthesiology) |
Related Diagnoses
-
J34.2- Deviated nasal septum- Relevant when surgical correction of a deviated septum is performed, requiring anesthesia.
-
J32.9- Chronic sinusitis, unspecified- Indicates chronic inflammation of the sinuses, which may necessitate surgical intervention under anesthesia.
-
J34.89- Other specified disorders of nose and nasal sinuses- Used for less common nasal or sinus conditions that require surgical management with anesthesia.
-
J33.9- Nasal polyp, unspecified- Represents nasal polyps that may be surgically removed, requiring anesthesia services.
-
J34.3- Hypertrophy of nasal turbinates- Refers to enlarged nasal turbinates, which may be treated surgically under anesthesia.
Related CPT Codes
-
01150: Anesthesia for procedures on the pelvis (except hip). This code is used for similar pelvic procedures and may be selected based on the specific surgical approach or complexity. -
01170: Anesthesia for procedures on the pelvis (except hip). This code is also related and may be used as an alternative depending on the exact nature of the pelvic surgery.
These codes are clinically related to 01160 and are often considered in the same workflow for pelvic procedures, with selection based on the surgical technique or patient factors. They are not typically used together but serve as alternatives for coding anesthesia services for pelvic operations.
National Reimbursement Benchmarks
Nationally, the mean rate for CPT code 01160 among commercial payers (BUCA) is $122.46, while Medicare rates are not available in the input. Among individual commercial payers, Cigna has the highest mean rate at $248.08, followed by Blue Cross Blue Shield at $219.60, and Aetna at $161.75. UnitedHealth Group has the lowest mean rate at $65.66.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Blue Cross Blue Shield shows the tightest range ($100.50), indicating less variability in rates, while Cigna exhibits the widest range ($259.00), reflecting greater variability. Aetna and BUCA also display substantial dispersion, with ranges of $230.00 and $126.60, respectively. UnitedHealth Group has a relatively narrow range of $25.67.
The table and chart below present a detailed breakdown of national benchmarks for CPT code 01160 across major payers.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska exhibits a substantial rate spread for CPT code 01160, with Blue Cross Blue Shield showing the widest gap between the 25th and 75th percentiles ($298.50 minus $225.80 = $72.70). This spread is much larger than the more uniform rates seen with Aetna and UnitedHealth Group, where the 25th, 50th, and 75th percentiles are nearly identical. Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and Aetna are higher, while Cigna and UnitedHealth Group are below their respective national means.
The table and chart below present the full breakdown of mean rates and percentile distributions for each payer in Alaska, highlighting the significant variability in reimbursement across the major commercial insurers.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer in Alaska for CPT 01160, with a mean rate of $267.08.
- UnitedHealth Group offers the lowest mean rate at $75.12, significantly below both the state and national averages.
- The rate spread in Alaska is notably wider than national benchmarks, indicating greater variability in reimbursement across payers.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.